2°Expert skills
Palliative CareConsultants /
Teams
2°Expert skills
Palliative CareConsultants /
Teams
Palliative Care Skills...
Palliative Medicine Specialists • 2006 ABMS recognized subspecialty
10 of the 24 parent boards
• 12 month US fellowship, > 71 graduates
Class of 2011 - 2012
2006 – Palliative Medicine Recognized as Subspecialty by American Board
of Medical Specialties
1. 1 year Fellowship or
Experiential qualification
( 2006 – 2013 only)
Oversight: American
Committee Graduate Medical
Education
Accreditation: American
Academy of Family Practice
2. Certification exam
Multiple choice
ABIM: American
Board of Internal
Medicine
Internal Medicine
Family Medicine Anesthesiology
PediatricsSurgery
Emergency Medicine
OB / GYN
Physical Medicine & RehabRadiology (XRT)
Psychiatry & Neurology
10 Sponsoring Specialties
Hospice and
Palliative Medicine
Next Steps
• Clinical Competencies
Outcomes
• Teaching skillsPresentation
Facilitation
Bedside mentorship
• Leadership skills• Research project
360° Evaluation
1. Patient and family care
2. Medical knowledge
3. Practice-based learning and improvement
4. Communication and interpersonal skills related to process of providing care
5. Professionalism
6. System based practice
Internal Medicine
Family Medicine Anesthesiology
PediatricsSurgery
Emergency Medicine
OB / GYN
Physical Medicine & RehabRadiology (XRT)
Psychiatry & Neurology
10 Sponsoring Specialties
Hospice and
Palliative Medicine
Palliative Medicine Fellowship… Developing Clinical Capacity
Palliative Medicine Fellowship… Developing Clinical Capacity
Hypothesis
Training palliative medicine specialists will advance
palliative care delivery and increase opioid consumption
Int’l Palliative Medicine Fellowship
• Over 24 - 36 months
4 – 6 months at San Diego Hospice
2 visit by IPM
Faculty in-country
Competency-based
Practical bedside
mentorship,
not observership
Pilot: 11 Int’l Fellow Graduates• Demonstrated competencies to IPM faculty
All recognized as consultants
3 Jordan
2 Georgia
2 Mongolia
1 Slovenia
1 Spain
2 Vietnam
King Hussein Cancer Center Jordan
• Built palliative care program2 palliative medicine consultants
> 50 staff
10-bed inpatient unit ( of 140 beds )
Inpatient consults
Ambulatory outpatient clinics
Homecare
Saw > 2,000 patients in 5 years ( since October 2004 )
KHCCPallCareGrowth
280335
407478
288
13
41
0
100
200
300
400
500
600
2005 2006 2007 2008
Consultaion
Referral
178 171 126186
99 129169
1992331 75
82
812
50
52
0
100
200
300
400
500
600
2005 2006 2007 2008
6Month-1Year
3Month-6Month
3Week - 3Month
1 Day-3 Week
New Patients
Length of Stay
Urska LunderLjubljana, Slovenia
• Medical Director, Palliative Care, Golnik Hospital19 bed unit, consultation service,
home care
• MoH Pilot Pathway Project - 3 regions• Teaching extensively
Faculty European School of Oncology
• European Union Research on EOL• IPM Leadership Development Initiative
Gantuya TserendorjUlaanbaatar, Mongolia
• Medical Director, Palliative Care, National Cancer Center16 bed unit, consultation service,
outpatient clinics
• MoH agreed to pay for PC services• Teaching regularly across Mongolia• Member Board of Directors new
Foundation of First Lady of Mongolia dedicated to vaccination & palliative care
Reach of 11 Fellows
Direct: If each cares / influences careof 1,000 pts / yr, for 30 yr
Patients LivesEach Touched
11 Fellows 30,000 330,000 + families
Indirect: Teaching, research, advocacy
Next Step
Expanded international pilot project
NCI R25E grant 2011 – 2015
20 Fellows
Cyprus 2 Ghana 2 Tanzania 2
Egypt 1 ( + 1 ) Italy 1 ( + 1 )
Uganda 2
Georgia 3 Peru 1
Others… Brazil, Colombia, Rwanda ?
US pilot project
Address workforce shortage
Cohort 2: 23 Leaders, 10 Mentors
Argentina South Africa
NigeriaUganda
4 India2 Vietnam
AlbaniaArmenia
Serbia
Kenya
Turkey
Guatemala
ColombiaBrazil
Bangladesh
2 Mongolia
Nepal
Romania
5 Practices of Exemplary Leaders…
1. Model the way
2. Inspire a shared vision
3. Challenge the process
4. Enable others to act
5. Encourage the heart
Niche… Over 2 yearsDevelop Individual Development Plan ( IDP )
Build leadership skills ( self )
Residential courses - curriculum
Coaching
Apply leadership skills in practical palliative care activities
Mentorship by senior palliative care leaders
Advance palliative care capacity locally, regionally, globally
Attitudes about Leadership
Before Retrospective After1
2
3
4
5
Sco
re
Positive Negative
p = 0.0005
p = 0.05
Positive Negative
Before Retrospective After
Leadership Core Skills
BeforeRetrospective
After1
2
3
4
Mean(ñ
SEM
) Score
Self
BeforeRetrospective
After
Organizational
BeforeRetrospective
After
Regional/International
All p < 0.003
Self Organizational Regional /International
Palliative Care Activities…Latin America
• New PC undergraduate medical education curriculum 2 universities
• Beginning interdisciplinary post-graduate courses
• Improving PC E-learning course for doctors & nurses
Palliative Care Activities…Czech Republic
• Regular multi-disciplinary meetings in Cancer Institute, referrals
• New website for Czech Society of Palliative Care
• Palliative medicine recognized as new medical specialty
Palliative Care Activities…Africa
• Integrating PC into medical, nursing & dental schools
• Integrate palliative care in 10 hospitals in country
• Medication campaign to identify morphine stock-outs & resistance to guaranteed supplies
Palliative Care Activities…Vietnam
• First Dept. PC Ho Chi Minh Cancer Center
Beginning home care
• New PC unit Hanoi• Vietnamese
E-learning in PC
International Reach 2003 – 2015
Patients Participants Each Lives
• Presentations > 10,000 100 1 M
• Courses > 500 2000 1 M
• Fellows 11 + 20 10,000+.3 M+
• Leaders 19 + 23 10,000+.4 M+
> 2,7 M+
Key Message
A consistent, planned approach to education interventions and evaluation
over 5-10 years changesbehaviors and the experiences of
patients and families, organizations and societies
Mohammad Bushnaqat End of Fellowship…
“ Overall, I can say it very clear that:
my experience with palliative care not only
changed my career, but also the way I am
looking to the life,
the way I communicating with people,
the way I am trying to understand others,
and how you can be a happy person by
working for noble ideas…
…Mohammad Bushnaq
“ I truly believe that palliative care is NOT
limited to terminally ill patients,
or even for sick person; but also
it is the answer for all people on earth,
for nations as a language to replace
the language of conflict between nations
we hear everyday in the media.
Call to Action in Sweden
Education
Standardized curricula
Trainees - students, residents
Practicing professionals
Specialty recognition
Fellowship training
“ The standards of practice we createand the people we train
will look after uswhen it’s our turn to receive care… ”
Will Sweden be ready ?